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For Medicaid benefits, beneficiaries generally enroll in their state's Medicaid FFS program or a Medicaid managed care plan administered by an MCO under contract with the state. Recently, Congress and CMS have placed greater emphasis on the coordination and integration of Medicare and Medicaid benefits for dual-eligible beneficiaries.
Medicare and Medicaid are different government-funded healthcare programs. To be eligible for both, a person will need to qualify for either partial-dual or full-dual coverage.
Medicare and Medicaid: Dual eligibility. A person may be eligible for both Medicare and Medicaid, which makes them dually eligible. This article looks at the rules, qualifying criteria, and more.
Medicare is the federal health insurance program in the United States for people age 65 and older. Medicaid is a joint federal and state program to help people with limited resources or income pay ...
Unlike Medicare, Medicaid is a means-tested, needs-based social welfare or social protection program rather than a social insurance program. Eligibility is determined largely by income. The main criterion for Medicaid eligibility is limited income and financial resources, a criterion which plays no role in determining Medicare coverage.
Because Medicaid and Medicare cover different aspects of health care, both have a financial incentive to shunt patients into care the other program pays for. Many experts have suggested that establishing mechanisms to coordinate care for the dual-eligibles could yield substantial savings in the Medicare program, mostly by reducing hospitalizations.
Medicare eligibility is typically determined by age or medical history, while Medicaid eligibility is based on income level. Medicaid and Medicare are often confused or used interchangeably.
The primary public programs are Medicare, a federal social insurance program for seniors (generally persons aged 65 and over) and certain disabled individuals; Medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families; and CHIP, also a ...
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